Heart and Vessels

, Volume 34, Issue 7, pp 1104–1112 | Cite as

U-shaped association of central pulse pressure with long-term prognosis after ST-segment elevation myocardial infarction

  • Gjin NdrepepaEmail author
  • Salvatore Cassese
  • Sebastian Kufner
  • Erion Xhepa
  • Massimiliano Fusaro
  • Karl-Ludwig Laugwitz
  • Heribert Schunkert
  • Adnan Kastrati
Original Article


The relationship between central pulse pressure (CPP) measured at the time of primary percutaneous coronary intervention (PPCI) and long-term prognosis after ST-segment elevation myocardial infarction (STEMI) has not been investigated. CPP measurements were performed in 1348 patients with STEMI (327 women; mean age 62.5 ± 12.1 years) undergoing PPCI. Aortic systolic and diastolic blood pressure was measured before intervention. The primary outcome was 8-year all-cause mortality. The median [25–75th percentile] CPP value was 55.0 [43.0–70.0] mmHg. CPP correlated negatively with heart rate (P < 0.001), body mass index (P = 0.007), Killip class (P < 0.001) and initial area at risk (P < 0.001) and positively with age (P < 0.001), female sex (P < 0.001), diabetes (P = 0.012), arterial hypertension (P < 0.001) and glomerular filtration rate (P = 0.004). There were 181 deaths over the follow-up. In patients with CPP within the 1st, 2nd and 3rd tertiles, the Kaplan–Meier estimates of mortality were 17.3%, 10.8% and 24.2%, respectively; univariable hazard ratio [HR] =1.52, 95% confidence interval [CI] 0.99 to 2.32; P = 0.055 for tertile 1 vs. tertile 2 and HR =2.09 [1.36–3.21]; P < 0.001 for tertile 3 vs. tertile 2. For CPP values lower than 35 mmHg and higher than 71 mmHg, the association between CPP and all-cause mortality was significant (HR =1.276 [1.004–1.621] for the 35 mmHg value and HR =1.289 [1.003–1.657] for the 71 mmHg value) compared with the CPP reference value (54 mmHg). After adjustment, the association between CPP and all-cause mortality was attenuated (P = 0.304). In patients with STEMI undergoing PPCI there is a U-shaped association between CPP and mortality up to 8 years after PPCI.


Mortality Pulse pressure ST-segment elevation myocardial infarction 




Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.


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Copyright information

© Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Adult Cardiology, Deutsches Herzzentrum MünchenTechnische UniversitätMunichGermany
  2. 2.I. Medizinische Klinik, Klinikum Rechts Der IsarTechnische UniversitätMunichGermany
  3. 3.DZHK (German Centre for Cardiovascular Research)Partner Site Munich Heart AllianceMunichGermany

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